Diabetes Management Programme Diabetes Management Programme Name * Name First Name First Name Last Name Last Name Email * Phone * Date of Birth * Gender * MaleFemaleNon-BinaryPrefer Not to Say Type of Diabetes Type 1 DiabetesType 2 DiabetesPrediabetesGestational DiabetesOther Other Current Blood Sugar Level (if available) Recent HbA1c Level (if available) Do you use medication or insulin? No MedicationOral MedicationInsulin InjectionsInsulin Pump Do you have any diabetes-related complications? * Neuropathy (Nerve Damage) Retinopathy (Eye Problems) Nephropathy (Kidney Issues) Hypertension (High Blood Pressure) Diabetic Foot None Other Other Current Activity Level * Sedentary (Little to No Exercise)Lightly Active (1-2 Workouts Per Week)Moderately Active (3-4 Workouts Per Week)Very Active (5+ Workouts Per Week) Current Eating Habits Regularly Monitor Carb Intake Eat Processed Foods Often Skip Meals Frequently Follow a Low-Glycemic Diet Other Other Biggest Challenges in Managing Diabetes Controlling Sugar Cravings Meal Planning & Preparation Eating Out & Social Events Maintaining a Healthy Weight Other Other Any Food Allergies or Restrictions? Dairy-Free Gluten-Free Nut Allergy None Other Other Meal Plan Preferences * Quick & Easy Recipes Budget-Friendly Meal Plans Family-Friendly Options Exercise Preferences * Home-Based Workouts Walking & Low-Impact Exercises Gym-Based Workouts Strength Training & Resistance Training Do you experience stress frequently? Yes No How many hours of sleep do you get per night? Less than 55-67-88+ Package Selection Basic Diabetes Meal Plan 4000Advanced Plan with Coaching 15000Premium Plan with Weekly Adjustments 20000 Payment Terms and Condition I confirm that the information provided is accurate, and I agree to the terms of the Diabetes Management Programme. Control My Diabetes If you are human, leave this field blank.
